Small Parts Midterm

PT, PTT, and platelet count are required ______ most procedures

before

(more _____) Teratoma - embryonal cell carcinoma

benign

Pleomorphic adenoma

benign and most frequent tumor of the salivary glands; most commonly seen in the parotid gland; hypoechoic mass

Adenoma

benign thyroid neoplasm characterized by complete fibrous encapsulation

Sialadenosis

benign, painless enlargement of the salivary gland; usually affects both parotid glands; enlarged gland without hypervascularity

Biopsies should be taken in various portions of the mass to confirm

colloid or abnormal cells

Ascites drainage is a ________ sonography request

common

Goiter

enlargement of the hyperplastic thyroid gland that can be focal or diffuse; multiple nodules may be present

The role of the cytopathogy team is to ensure

enough diagnostic tissue is obtained; increase the percentage of successful biopsies; minimize the number of core samples; possibly reduces overall procedure time

nocturia

excessive urination at night

the superior thyroid artery is the 1st branch of the

external carotid artery

PTT (partial thromoplastin time) can be used to evaluate

factors found in the intrinsic and common pathways

Hydrocele

fluid formed between the visceral and parietal layers of the tunica vaginalis

Epididymal cyst

composed of clear fluid whereas spermatoceles are filled with thick milky fluid containing spermatozoa. Both lesions result from prior episodes of epididymitis.

Peripheral zone

comprises the posterior, lateral, and apical aspects of the prostate. The peripheral zone is the most common site for prostate cancer. It accounts for 70% of the prostate

Thyroglossal duct cysts

congenital anomalies that present in midline of the neck anterior to the trachea, superior to the thyroid gland and near the hyoid bone

The thyroid gland is ______ to the thyroid cartilage and larynx

inferior

apex

inferior region of the prostate

Sialadenitis

inflammation of a salivary gland - heterogeneous, hyperemic, visibly enlarged, and may contain diffuse hypoechoic regions

orchitis

inflammation of a testicle

Epididymitis

inflammation of the epididymis

Epididymo-orchitis

inflammation of the epididymis and testis

prostatitis

inflammation of the prostate

Thyroiditis

inflammation of the thyroid

The most common location of the cryptorchid testis is in the _______. Less than 10%of undescended testis are located in the abdomen.

inguinal canal or prescrotal positions

tunica albuginea

inner fibrous membrane surrounding the testicle

these arteries have corresponding thyroid veins that drains into the

internal juglar vein

Signs of malignancy in intratesticular masses include

irregular shape of the testis and the appearance of normal parenchyma around the mass. The presence of a large hydrocele is uncommon in malignancy and usually indicates a benign condition. Small hydroceles are a common feature of testicular cancer. The presence of a swollen epididymis or scrotal wall swelling in combination with a testicular mass is suggestive of orchitis rather than tumor. Color or power Doppler may show disorganized hyperemic blood flow around a malignant tumor. However, small tumors (<1.5 cm) may not demonstrate typical tumor vascularity

verumontanum

junction of the ejaculatory ducts with the urethra

Serum calcium

laboratory value that is elevated with hyperparathyroidism

Sternocleidomastoid muscles

large superficial muscles anterolateral to the thyroid and strap muscles

the common carotid artery and the internal jugular vein are _______ to the thyroid gland

lateral

In renal biopsies, the _______ is preferred, as it offers a safer approach than the right. Typically, the lower pole is biopsied because it lies more posterior than the other poles.

left kidney

Typically, the ________ patient position is used in a prostate biopsy

left lateral decubitus

The _____ is the most common organ biopsied for either specific areas or masses or for diffuse parenchymal disease.

liver

normal measurements

lobes: 4-6cm length, 2-3cm width, 1-2 cm height isthmus: 2cm length, 2cm width, 2-6mm

extrathyroidal parathyroid adenoma

located posterior and echogenic line of separation from the normal thyroid gland

hypotension

low blood pressure

Hypophosphatasia

low phosphatase level, which can be seen with hyperparathyroidism

Spectral Doppler can be used to differentiate arterial from venous flow and to characterize arterial resistance. Doppler waveforms obtained from the capsular and intratesticular arteries show

low-resistance profiles characterized by high end-diastolic flow velocities. The resistive index (RI) and pulsatility index (PI) measurements obtained from these arteries show low values indicative of the low resistance to blood flow. Waveform analysis of the arteries within the spermatic cord may show either low-or high-resistance patterns as the vessels are intertwined. The testicular artery demonstrates a low-resistance waveform, whereas the cremasteric and deferential arteries will show high-resistance waveforms (very little diastolic flow with high RI and PI values)

Seminoma spreads initially to draining ______ in the retroperitoneum. When an intratesticular mass is discovered, paraaortic region should be evaluated for lymph nodes

lymph nodes

testicle

male gonad that produces hormones that induce masculine features and spermatozoa

The common indication for a biopsy is to confirm a _________ in a mass

malignancy

All intratesticular masses should be considered potentially _____ until proven otherwise.

malignant

yolk sac tumor - choriocarcinomas (more_______)

malignant

punctate

marked with dots

Calcifications ("Scrotal Pearls")

may be located within the testicle or between the layers of the tunica vaginalis

Platelete count

measures the number of platelets in blood sample.

The esophagus is located posterior and _____ to the left lobe of the thyroid

medial

The left of the thyroid is _____ to the left CCA and IJV

medial

The right lobe of the thyroid is ____ to the right CCA and IJV

medial

Metastatic disease to the testis is most commonly from

melanoma, lung, kidney, and prostate cancer

septa testis

multiple septa formed from the tunica albuginea that course toward the mediastinum testis and separate the testicle into lobules

Inguinal canal

normal passageway in the lower anterior abdominal wall that allows foe the passage of the spermatic cord into the scrotum

normal parathyroid glands are ____ generally seen on sonography

not

Follicular carcinoma

occurs as a solitary malignant mass within the thyroid gland

chorionic villus sampling

sampling of placental tissues for prenatal diagnosis of potential genetic defects

thyroid inferno

the sonographic appearance of hypervascularity demonstrated with color Doppler imaging of the thyroid gland

mediastinum testis

the structure that is formed by the tunica albuginea and contains the rete testis

median raphe

the structure that separates the scrotum into two compartments externally

Answer Appendix epididymis

the testicular appendage located at the head of the epididymis

Appendix vas

the testicular appendage located between the body and tail of the epididymis

Appendix testis

the testicular appendage located between the head of the epididymis and the superior pole of the testis

the inferior thyroid artery is a branch of the _______ of the subclavian artery

thyrocervical trunk

Blood tests to measure TSH, T4, T3 and Free T4 are readily available and widely used to assess _________

thyroid function.

Microcalcifications

tiny echogenic foci within a nodule that may or may not shadow

Subacute (de Quervain's) thyroiditis

viral infection of the thyroid that causes inflammation

Longus colli muscle

wedge-shaped muscle posterior to the thyroid lobes and CCA, on the anterior surface of the vertebral column

tunica vaginalis

membrane consisting of a visceral layer (adherent to the testis) and a parietal layer (adherent to the scrotum) lining the inner wall of the scrotum; a potential space between these layers is where hydroceles may develop

Papillary carcinoma

most common form of thyroid malignancy

Mucoepidermoid carcinoma

most common malignancy of the salivary glands; typically starts in the parotid gland; hypoechoic or heterogeneous mass with moderate to marked internal vascularity

Describe anapestic carcinoma

- highly malignant and grows rapidly - typically a disease of the elderly

normal thyroid parenchyma sonographic appearance

- homogenous - consist of medium - to high-level echogenicity. That is greater than the strap muscles and similar to testes

Men with elevated _____ levels or palpable nodules found on a rectal digital examination may be referred for a prostate biopsy

PSA

4 main types of thyroid cancer

Papillary carcinoma Follicular carcinoma Medullary carcinoma Anaplastic carcinoma

_______ is sometimes helpful in identifying abnormalities of the parathyroid glands

Parathyroid MIBI scan (Nuclear Medicine)

Ejaculatory ducts

connect the seminal vesicle and the vas deferens to the urethra at the verumontanum

Hyperthyroidism

TSH decreases; T3/T4 increases

Hypothyroidism

TSH increases; T3/T4 decreases

hematocele

contains blood and would therefore be more likely to be associated with trauma. Because of the blood cells within it, a hematocele will show low-level echoes with ultrasound

spermatocele

cyst of the vas deferens that contains sperm

Spermatoceles

cystic masses of the epididymis that result from dilatation of the epididymal tubules; more common than epididymal cysts; usually occur at the epididymal head.

Hypovolemia

decreased blood volume

Nodular hyperplasia

degenerative nodules within the thyroid

Stensen duct

the main duct of the parotid gland

Digital rectal examination

the medical procedure that requires the insertion of the finger into the rectum to palpate the prostate gland and lower gastrointestinal tract

testicular vein

the pampiniform plexus forms each testicular vein; the right testicular vein drains directly into the inferior vena cava, whereas the left testicular vein drains into the left renal vein

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandates a "time-out" before any procedure. A "time-out" includes

the patient reciting her or his full name, and the patient's identification number is confirmed along with the type and location of the procedure

Hematospermia

the presence of blood within the semen

biopsy

the removal of living tissue from the body for diagnostic examination

The scrotal wall thickness ranges between ______, great than ____ mm is considered as abnormal.

- 2 and 8 mm - 10

Describe follicular carcinoma

- 2nd most common type of thyroid cancer - occurs later in life, especially in women -spreads via bloodstream rather than through nodes, so distant metastases to the bone, lungs, brain, and liver are more likely than metastasis to cervical lymph nodes

The size of the Testis. Adult testicles measure ____ cm in length, ____ cm in width, and __ cm in thickness

- 3 to 5 - 2 to 4 - 3

The wait time for discontinuing aspirin is __________ ; for heparin, ________ is the wait time; and for Coumadin, the wait time is ________.

- 5 to 7 days - 4 to 6 days - 3 to 4 days

It is a true surgical emergency in which time is of the essence. Salvage rates range from 80% to 100% if the patient is treated within __ hours of symptom onset. After this time, the salvage rates drop considerably. The testicle is usually not salvageable after __ hours.

- 6 - 24

What is tunica albuginea?

- A dense, fibrous connective tissue membrane completely surround the testis - Is surrounded by the parietal layer of the tunica vaginalis. - It converges at the posterior surface of the testis and is reflected interiorly as a vertical septum known as the mediastinum testis. - Inserts int the posterior aspect of the testicle, where the efferent ductulus and blood vessels enter to form a vertical septum called the mediastinum - is a peritoneal sac that lines the inner walls of the scrotum, covering each testis and epididymis

Describe the sonographic findings of a varicocele

- A group of anechoic, tubular structures located outside of the testis - Distended veins that fill with color flow when the Valsalva maneuver or with abdominal compression is performed - Dilated veins that measure greater than 2 mm - Possibly associated with hydronephrosis, hepatomegaly, or a retroperitoneal neoplasm if found on the right - B-Mode imaging usually displays most varicoceles. Improved visualization can be achieved by performance of the Valsalva maneuver or scanning the patient in an upright position. Color or power Doppler is very helpful in delineating the dilated veins and differentiating varicocele from other anechoic extratesticular structures.

Describe the clinical findings of epididymitis and epididymo-orchitis

- Acute epididymis is the most common condition that causes acute scrotal pain. - Acute testicular pain - Leukocytosis - Fever - Dysuria - Urethral discharge - Scrotal wall edema - Pyuria

Describe the clinical findings of acute testicular torsion

- Acute onset of testicular pain (often during sleep), sudden onset - Possible pain within the lower abdomen and inguinal region - Swollen testis/scrotum - Nausea and vomiting - Leads to venous occlusion and arterial ischemia causing infarction of the testicle. Torsion more often involves the left testicle.

Describe the clinical findings of Hashimoto thyroiditis

- Autoimmune thyroid disease - typically occurs as a painless, diffuse enlargement of the thyroid in young or middle-aged woman - common cause of hypothyroidism - depression - increased cold sensitivity - elevated blood cholesterol levels - slight weight gain may occur - puffy face and puffiness under the eyes

The number of the gauge corresponds to the diameter of the needle: the _______ the number, the _____ the diameter

- higher - smaller

What is vas deferens?

- Beginning with the body and ending at the tail of the epididymis, the vas deferens is formed from these structures - The vas deferens ascends medially and cephala and carries semen - The vas deferens continues cephalad until reaching an ampulla just proximal to the prostate and adjacent to the seminal vesicles

Describe the sonographic findings of a pyocele

- Complex fluid collection within the scrotum - Scrotal wall thickening - May be seen in conjunction with rupture of a testicular abscess

Describe the sonographic findings of a testicular abscess

- Complex intratesticular mass - An enlarged testicle containing a predominantly fluid-filled mass with hypoechoic or mixed echogenic areas - Mass that has no flow centrally but increased flow around its margins - May have a coexisiting pyocele

Describe the risk factors of seminoma

- Cryptorchidism (undescended testicles) - Family history of testicular cancer - Infertility - Klinefelter syndrome (XXY) - Down syndrome - Smoking - white race

What is scrotum?

- Cutaneous, fibromuscular sac - Divided internally into two sacs by median raphe - Each contains a single testis

Describe the sonographic findings of epididymitis and epididymo-orchitis

- Enlargement of the entire epididymis (diffuse) - Enlargement of only part of the epididymis (focal) - Hypoechoic echotexture of the affected section(s) of the epididymis - Hypoechoic testis (with orchitis) - Hyperemia within the epididymis and/or testis - Thickened scrotal wall - Reactive hydrocele - This infection may extend into the testicle causing orchitis. Sonographically, orchitis is seen as an enlarged and hypoechoic testicle with increased blood flow - Color Doppler is an essential tool in the evaluation of testicular torsion and epididymo-orchitis. It does not add any pertinent information in evaluation of testicular microlithiasis.

Describe the sonographic findings of acute testicular torsion

- Enlargement of the spermatic cord, epididymis, and testis - Thickened scrotal wall - Hypoechoic or heterogeneous testis - Reactive hydrocele - No intratesticular flow - Decreased intratesticular flow (as compared to the asymptomatic testis

Describe the sonographic findings of an inguinal hernia

- Heterogeneous mass within the scrotum that moves (peristalsis) - Mass may contain air and fluid - Hydrocele may be present - The presence of peristalsis confirms the diagnosis. - Small inguinal hernias can be visualized by using the Valsalva maneuver

Describe the laboratory values related to serum tumor markers

- High levels of serum AFP is more suggestive non-seminomas - Serum beta-hCG is seen in both seminomas and non-seminomas - Beta-human chorionic gonadotropin - Alpha-fetoprotein

Describe papillary carcinoma

- Most common thyroid cancer - represents most thyroid cancer (75%-90% of thyroid cancers) and is the least aggressive - has a good prognosis if treated early - is often multifocal with cervical lymph node metastases present early in the course of the disease - the presence of nodal metastasis in the neck does not adversely alter the prognosis

Describe the clinical findings of a testicular abscess

- Painful, swollen scrotum - Fever - Leukocytosis - Usually a complication of epididymo-orchitis

Describe the clinical findings of a seminoma

- Painless scrotal mass - Hardening of the testis - Elevated hCG

Describe the sonographic findings of scrotal trauma

- Possible fracture line - Indistinct testicular margins - Hematocele

_________ lymph nodes are usually suspicious for cancer as opposed to _____ nodes with echogenic centers from a fatty hilum

- Round, homogeneous - oval

Describe the sonographic findings of a hydrocele

- Simple anechoic fluid anterior to the testis without internal septations - Scrotal wall thickening - Chronic hydroceles may have internal debris and septations - Low-level echoes from fibrin or cholesterol crystals may be visualized within the hydrocele - A small hydrocele may be present with malignancy, but large hydroceles are most commonly associated with inflammation such as orchitis and epididymitis. Neither a varicocele or epididymal cyst is associated with hydrocele formation

Describe the sonographic findings of a seminoma

- Solid, predominantly hypoechoic well-demarcated and sometimes multifocal intratesticular mass - A homogeneous echo texture is usually present - Large seminomas may become heterogenous, may show bright areas due to internal hemorrhage

List the testicular cancer staging

- Stage I tumor confined to the testicle They are very radiosensitive,and stage 1 seminomas have a high cure rate (95-100%). - Stage II tumor spread to lymph node - Stage III tumor spread to lungs, brain, liver

Describe the blood supply to the scrotum

- The blood supply to the scrotum is derived from three vessels - the testicular, deferential, and cremasteric arteries. - The testicular artery arises from the abdominal aorta just below the level of the renal artery on each side. - It courses through the spermatic cord to the mediastinum testis where it branches into capsular arteries. - The capsular arteries give origin to the centripetal arteries that course through the testicular parenchyma toward the mediastinum. - Near the mediastinum, the centripetal arteries branch into the recurrent rami (centrifugal arteries), which travel in the opposite direction. - The vas deferens and epididymis receive blood from the deferential artery, which is a branch of the vesical artery. - The peritesticular tissue is supplied by the cremasteric artery, which is a branch of the inferior epigastric artery

What is epididymis?

- The efferent ducts empty into the epididymis - The epididymis lies along the posterolateral aspect of the testis and is made up of a head, body, and tail - Its size is 6-7 cm in length, 0.6-1.5 cm in width, and it contains more than 6 meters of coiled tubul

Describe the drainage of blood from the scrotum

- The testicle is drained by a network of veins that arise from the mediastinum to form the pampiniform plexus converges into three veins, the testicular, the deferential, and the cremasteric vein - The right testicular vein drains directly into the inferior vena cava and the left drains into the left renal vein

What is testes/testicles (plural) testis (single) including size, shape?

- The testis is an ovoid shaped male reproductive gland measuring approximately 4*3*3 cm. - It is divided into more than 250 conical lobules containing the seminiferous tubules. - These tubules converge at the apex of each lobule as the tubuli recti. - The rete testis is formed by the anastomosis of these tubules in the mediastinum. - It is connected to the head of the epididymis throughout the efferent ducts.

Describe the clinical findings of a hydrocele

- Transilluminates light - Painless scrotal swelling - May present with pain when found in the presence of scrotal infections, testicular torsion, trauma, or a tumor - May be congenital or acquired - May be idiopathic

Describe the clinical findings of scrotal trauma

- Trauma to the scrotum resulting in acute scrotal pain - Low hematocrit

Describe the clinical findings of a Varicocele

- Typically, painless (large varicoceles can cause discomfort) - Palpable extratesticular mass - Possible infertility - 90% of the varicoceles are on the left side. This is due to the length of the left testicular vein as it drains into the left renal vein - Unilateral scrotal pain may be associated with varicocele thrombosis

Color Doppler plays a very important role in ultrasound evaluation of the scrotum. Color Doppler equipment should demonstrate adequate sensitivity to detect intratesticular flow in all normal patients. Describe how to get optimal color Doppler?

- Use of low pulse repetition frequency (PRF) and low wall filter settings. - Increasing the packet size (number of sound pulses per line) improves sensitivity to flow by improving the signal-to-noise ratio. - Use of high Doppler frequencies improves demonstration of slow flow but decreases penetration. - Color gain should be maximized to the background noise limit to improve visibility of the small intratesticular vessels.

Laboratory tests which measure the time it takes the blood to form a clot should be reviewed before most procedures, test results should be obtained as close to the date of the procedure as possible. This is especially true for patients on blood thinners such as what three drugs?

- Warfarin (Coumadin) - heparin - aspirin

thyroid cysts

- account for 20% of all cold lesions on nuclear medicine studies - true thyroid cysts are rare - typically benign - usually results from hemorrhage or cystic degeneration of an adenoma

Describe sonographic findings of a thyroglossal duct cyst

- anechoic - well defined - unilocular cyst with posterior enhancement - may have internal components - cystic midline mass typically seen in adolescents associated with an upper respiratory infection - cystic dilation of thyroglossal duct which is a remnant of the thyroid gland migration from the pharyngeal epithelium

Describe sonographic findings of a brachial cleft cyst

- anechoic mass near the angle of the mandible - are a remnant of embryonic development - may be connected to the mouth and become infected - solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the mandible under the sternocleidomastoid muscle

Describe the location of thyroid gland

- anterior portion of the neck - right and left lobes drape laterally over the larynx - isthmus is located anterior to the larynx

Describe the clinical findings of Grave's disease

- autoimmune disorder - most common cause of hyperthyroidism - bulging eyes (exophthalmos) - heat intolerance - nervousness - weight loss - hair loss - rapid heart rate - muscle atrophy

Most extratesticular masses are _____, but the majority of intratesticular lesions are _____.

- benign - malignant

Describe the sonographic findings of Hashimoto thyroiditis

- diffuse enlargement of the thyroid gland - heterogenous echotexture - multiple, ill-defined hypoechoic regions separated by fibrous hyperechoic tissue - hypervascularity gland

Some abnormal values that may trigger a request for a biopsy or aspiration include

- elevated alpha-fetoprotein (AFP) in the presence of a liver lesion - elevated prostate-specific antigen (PSA) to evaluate for prostate cancer - changes in thyroglobulin levels in a patient with a history of thyroid cancer - increased white blood cell count (leukocytosis) when an abscess is suspected - hematuria along with a renal mass.

primary hyperparathyroidism

- elevated serum calcium - elevated PTH

Describe the sonographic findings of Grave's disease

- enlarged gland - heterogenous or diffusely hypoechoic echotexture - thyroid inferno - hypervascularity is noted with color flow doppler - presence of thyroid-stimulating immunoglobulins (TSI) is diagnostic of Grave's disease

Describe the sonographic findings of a goiter

- enlarged thyroid gland - diffusely heterogeneous echotexture - multiple nodules with cystic and solid components

Describe sonographic findings of abnormal lymph nodes

- enlargement of the node >1 cm - rounded shape - loss of the echogenic hilum - calcifications - may be hyperemic or demonstrate abnormal vascular patterns with color doppler - normal lymph nodes are less than 1-1.5 cm in size, elliptical in shape.

Describe benign characteristics of thyroid nodules

- extensive cystic components - cyst <5mm - hyperechoic mass - eggshell calcifications - hot nodule

describe malignant characteristics of thyroid nodules

- hypoechoic mass - taller than wide shape - mass with internal micro calcifications (psammoma bodies) - solitary mass - marked vascularity within the central part of the nodule - interrupted peripheral calcification - extra capsular invasion - lobulated margins - enlargement of the cervical lymph nodes (metastasis) - cold nodule - mass is firm and nontender

There are multiple reasons that lead to an inconclusive result, including

- insufficient material - necrotic lesion - not biopsying the area of malignancy

most common ectopic location include

- intra-thyroid - mediastinum - near carotid bifurcation

Describe medullary carcinoma

- is uncommon - typically exhibits microcalcifications - typically secretes the hormone calcitonin which can be useful serum marker - associated with multiple endocrine neoplasia syndrome

Describe the clinical findings of an inguinal hernia

- may consist of intestine or omentum - Results in from bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum - Persistent or intermittent scrotal swelling - May have abdominal pain and blood in stool

Describe the clinical findings of a goiter

- palpable enlarged thyroid gland - dyspnea - dysphagia - feelings of tightening on the throat - coughing - hoarseness

Describe clinical findings of abnormal lymph nodes

- palpable neck mass - enlarged nodes may be painful - causes of enlarged lymph nodes include local infection, mononucleosis. metastatic disease

parathyroid glands are

- round/oval - hypoechoic structures normally less than 0.5 cm in size

what are the adenomas

- typically found in elderly women - can be multiple and contain functioning thyroid tissue - a hyperechoic, hypoechoic, or isoechoic mass with a hypoechoic halo is typical finding

Testicular torsion occurs more often during adolescence, between

12 - 18 years of age

Fine-needle aspiration (FNA), or cytologic aspirarion, uses thin-gauge needles to obtain cells form within the mass. FNA is performed using a ________ needle, preferably with a cutting tip, such as a Franseen, Chiba, or spinal needle

20- to 25-gauge

There are ____ parathyroid glands

4, 2 on each side of the thyroid

Germ cell tumors comprise _____ of all testicular tumors. The most common germ cell tumor is seminoma (40-50%).

93-95%

Describe the sonographic appearance of the normal testis.

A homogeneous medium-level echo texture.

Hypercalcemia

An excessive amount of calcium in the blood; associated with hyperparathyroidism

____ or congenital absence is rare and accounts for only 4% of patients who present with cryptorchidism

Anorchia

testicular artery

Artery arising from the aorta just distal to each renal artery; it divides into two major branches, supplying the testis medially and laterally

bengin prostatic hypertrophy

BPH, enlargement of the prostate gland, Causes: old age, when prostate gland enlarged begins to block urine flow, Signs: painful urination, frequent urination, noturia, Treatment: meds, surgery, therapy, TURP,

Exophthalmos

Bulging of the eyeballs, associated with hyperthyroidism

_____ are typically used to image an abdominal testis, although imaging posterior to a filled bladder may aid in the abdominal evaluation by ultrasound

CT and MRI

_____ may on occasion be helpful, but ultrasound is by far the preferred modality to assess the thyroid, parathyroid and cervical lymph nodes

CT and MRI

________ responsible for removing calcium from the blood for storage in the bones

Calcitonin

Nutcracker syndrome

Compression of left renal vein between SMA and aorta

Klinefelter Syndrome (XXY)

Extra X chromosome is present in male causing: - infertility - small testicles - gynecomastia - long legs - abnormal low intelligence

How to evaluate the thyroid masses?

Fine needle aspiration (FNA) is the most effective method for diagnosing malignancy in a thyroid nodule

__________ are the most common testicular cancers. They are classified as either seminoma or nonseminoma, based on their histology.

Germ cell tumors

A standard method was developed called the ____________ because of the variability of PT results among laboratories

INR (international normalized ratio)

________ are complications of cryptorchidism. Patients with cryptorchidism have an increased risk of developing a malignancy in both the undescended testis and the contralateral testis.

Infertility and cancer

What is the tunica vaginalis

It is composed of two layers, parietal visceral. The parietal layer is the inner lining of the scrotal wall. The visceral layer covers the testis and epididymis. The space between these two layers of the tunica vaginalis normally contains a small amount of fluid. Hydroceles form in this space. A bare area exists where the tunica vaginalis does not cover the posterior aspect of the testis.

Testicles are usually descended at birth, although spontaneous descent may occur in the first year. _______ is the treatment of choice and is usually performed on patients aged 2-10 years.

Orchiopexy

The benefit of Power Doppler in the evaluation of the scrotum

Power Doppler is beneficial in the evaluation of the scrotum. Because aliasing is not displayed with power Doppler, the PRF can be reduced to improve sensitivity without detrimental effect. Additionally, the absence of aliasing results in excellent demonstration of testicular arterial anatomy.

What is primary malignancy?

Primary tumor in a patient with an undiagnosed malignancy (The original cancer site)

Percutaneous Umbilical Blood Sampling (PUBS)

Procedure for obtaining fetal blood through ultrasound-guided puncture of an umbilical cord vessel to detect fetal problems such as inherited blood disorders, acidosis, or infection; also called cordocentesis.

hepatorenal syndrome

Progressive renal failure associated with hepatic failure characterized by a sudden decrease in urinary output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and increased urine osmolarity

______ biopsies are requested on patients with proteinuria, nephrotic syndrome, and renal failure

Renal

De Quervain Syndrome

Subacute thyroiditis secondary to a viral infection

___________ will appear as multiple echogenic foci with no acoustic shadowing within the testis. These tiny calcifications have been associated with malignancies, infertility, Klinefelter syndrome and cryptorchidism

Testicular microlithiasis

Describe the sonographic appearance of the normal epididymis?

The epididymis is normally isoechogenic or slightly more echogenic than the testis

Myxedema

The most severe form of hypothyroidism, characterized by swelling of the hands face and feet. May lead to coma and death

What is the meaning of low resistance within the testicular parenchyma?

The normal arterial waveform within the testicular parenchyma is described as low resistance. This means that there is forward flow throughout the cardiac cycle without cessation at any point.

Paracentesis

The removal of fluid from a body cavity via a needle, a trocar, a cannula, or another hollow instrument

What does the spermatic cord consist of

The spermatic cord consists of the testicular, cremasteric, and deferential arteries as well as the vas deferens, lymphatics, nerves of the testis, and a pampiniform plexus of veins

________ biopsies can be helpful in distinguishing malignant masses from goiters or adenomas.

Thyroid

__________________ aids in the metabolism of fats, proteins, and carbohydrates

Thyroxin (T4) and Triiodothyronine (T3)

3 thyroid hormones

Thyroxine (T4) Triiodothyronine (T3) Calcitonin

The most common correctable cause of male infertility

Varicocele

Describe the causes, complications, diagnose of varicocele.

Varicocele are dilated veins of the pampiniform plexus. Most occur due to incompetent valves of the testicular vein. Other etiologies include renal vein thrombus or tumor extension on the left side. Varicoceles have been shown to be associated with infertility. They are much more common on the left than the right. Veins larger than 2 mm in the supine position or 2.5mm in the standing position are considered to be abnormal. It is best to over diagnose rather than under diagnose varicoceles in the fertility so as not to misdiagnose a potentially treatable cause of infertility.

Psammoma bodies (microcalcofication)

round, punctate calcific deposit

In general, inflammation almost anywhere in the body increases the vascularity seen with color Doppler

With torsion, no flow is present within the testicle, orchitis is inflammation of the testicle, so hyperemic flow is apparent with color Doppler. No flow is seen within a hydrocele, although color signals due to particle streaming of the hydrocele fluid may be detected. Blood flow id absent in areas of infarction, and therefore no color Doppler signal is detected

Hematocele

a collection of blood located between the visceral and parietal layers of the tunica vaginalis

Epididymal cyst

a cyst located anywhere along the length of the epididymis;cyst filled with clear, serous fluid located in the epididymis

Thyroid-stimulating hormone (TSH)

a hormone secreted by the pituitary gland that stimulates the thyroid gland to secrete thyroxine and triiodothyronine

Parathyroid hormone (PTH)

a hormone that is secreted by the parathyroid glands, which regulate serum calcium levels

Secondary malignancy?

a metastatic mass in a patient

pyramidal lobe

a normal variant extending superior to the isthmus; Agnes's of a lobe may also occur

scintigraphy (thyroid)

a procedure to image the thyroid gland. 99m-Tc pertechenetate is the radiopharmaceucal administered intravenously and imaged on a gamma camera.

hysteroscopy (HYS)

a procedure to look at the inside of a uterus. this procedure is commonly used to diagnose bleeding problems in women, remove polyps or fibroids or perform other procedures

prostate-specific antigen (PSA)

a protein produced by the prostate gland

Chlamydia

a sexually transmitted disease that can lead to infection of the genitals

Calcitonin

a thyroid hormone that is important for maintaining a dense, strong bone matrix and regulating the blood calcium leve

Germ cell tumor

a type of neoplasm derived from germ cells of the gonads; may be found outside of the reproductive tract

Cryptorchidism

also called undescended testes; testicles remain within the abdomen or groin and fail to descend into the scrotal sac the condition of having an undescended testis or testicles; is associated with infertility and an increase in the risk for malignancy in the involved testis; most often found just above the scrotum or within the inguinal canal

Sjogren's syndrome

an autoimmune disease that a%ects all glands that produce moisture; leads to dysfunction of the salivary glands and severe dryness of the eyes, nose, skin, and mouth

Cremasteric muscle

an extension of the internal oblique muscle that descends to the testis with the spermatic cord; contraction of the cremasteric muscle shortens the spermatic cord and elevates the testis

Epididymis

anatomic structure formed by the network of ducts leaving the mediastinum testis that combine into a single, convoluted epididymal tubule; located on the posterolateral aspect of the testis; the epididymis consists of the head, the body, and the tail; spermatozoa mature and accumulate within the epididymis

Sonographically both lesions appear identical

anechoic, well-defined masses with no or few internal echoes

The isthmus of the thyroid gland is _____ to the trachea

anterior

The strap muscles are located _____ to the thyroid

anterior

The sternocleidomastoid muscles (SCM) are located ______ to the thyroid

anterolateral

Testicular microlithiasis

are frequently seen sonographically. Microlithiasis has not been proven to define a benign or malignant testicular condition

Intratesticular cyst

are normally located near the mediastinum testis and probably originally from the rete testis.

Deferential artery

arises from the vesicle artery (a branch of the internal iliac artery) and supplies the vas deferens and epididymis

The needle tip should appear

as an echogenic dot

Graves' disease

autoimmune disorder characterized by a diffuse toxic goiter, exophthalmos (bulging eyes), and cutaneous manifestations, the most common cause of hyperthyroidism

A core biopsy, utilizes an automated, spring-loaded devices, termed a ______. It provides tissue for histologic analysis. The throw length is the distance that the needle will advance when fired.

biopsy gun

fine needle aspiration (FNA)

biopsy technique that uses a narrow hollow needle to obtain tiny amounts of tissue for pathologic examination

pleural effusion

build-up of excess fluid between the layers of the pleura outside the lungs

corpora amylacea

calcifications in inner gland of prostate

parathyroid glands secrete parathyroid hormone, which regulates

calcium and phosphorus metabolism

Hashimoto's thyroiditis

chronic inflammation of the thyroid gland caused by the formaon of antibodies against normal thyroid issue; a progressive autoimmune inflammatory disorder of the thyroid gland; most common cause of hypothyroidism

scrotum

sac containing the testes and epididymis

thermal ablation

destruction of tissue by extreme hyperthermia or hypothermia.

he cytopathologist looks at the slides to determine if the material is

diagnostic

dyspnea

difficulty breathing

Dysphagia

difficulty swallowing

variocele

dilated veins in the pampiniform plexus caused by obstruction of the venous return from the testicles

Hyperparathyroidism

disorder associated with elevated serum calcium level, usually caused by a benign parathyroid adenoma; may lead to osteoporosis and nephrolithiasis

Lymphadenopathy

disorder characterized by localized or generalized enlargement of the lymph nodes or lymph vessels

Parathyroid hyperplasia

enlargement of multiple parathyroid glands

Secondary hyperparathyroidism

enlargement of parathyroid glands in patients with renal failure or vitamin D deficiency

Two methods in performing ultrasound-guided procedures

free-hand techniques and the use of needle guides

Idiopathic

from an unknown origin

Bulbourethral gland

gland that secretes pre-ejaculate fluid that lubricates the penile urethra prior to ejaculation; also referred to as the Cowper gland

Strap muscles

group of three muscles (sternothyroid, sternohyoid, and omohyoid) that lie anterior and lateral to the thyroid

Bell-clapper deformity

he condition in which the patient lacks the normal posterior fixation of the testis and epididymis to the scrotal wall; classically bilateral

Specific complications of a renal biopsy include

hematuria and a perinephric hematoma

PTT (partial thromoplastin time) can be used to evaluate the effects of

heparin, aspirin, and antihistamines on the blood-clotting process.

Human chorionic gonadotropin

hormone produced by the trophoblastic cells of the early placenta; may also be used as a in nongravid patient and males

most common manifestation of multiple endocrine neoplasia (MEN type 1) resulting in

hyperplasia of all four parathyroid glands (secondary hyperparathyroidism)

Most malignant testicular neoplasms are ______ compared to the normal testicular parenchyma

hypoechoic

the pituitary gland is regulated by the

hypothalamus

Medullary carcinoma

neoplastic growth that accounts for 10% of thyroid malignancies

Multinodular goiter

nodular enlargement of the thyroid associated with hyperthyroidism

secondary hyperparathyroidism

occurs in patients with chronic renal failure, the inability of kidneys to filter results in increased amounts of serum phosphates - all 4 parathyroid glands enlarge - elevated serum phosphates - serum calcium decreases

Hyperthyroidism

over secretion of thyroid hormones, associated with Graves' disease

Primary hyperparathyroidism

oversecretion of parathyroid hormone, usually from a parathyroid adenoma

Most ______ mass biopsies are performed to confirm the diagnosis of adenocarcinoma, unresectable adenocarcinoma, or pancreatitis in patients with unusual imaging findings

pancreatic

_______ most common cause of enlargement of a parathyroid gland

parathyroid adenoma

the inability to synthesize vitamin D depresses the serum calcium level which stimulates

parathyroid gland hyperplasia

High blood calcium levels and high blood parathyroid hormone (PTH) are indicative of ________

parathyroid tumor

The preprocedural image should document the

patient's name and the time, date, and demonstration of the needle path.

thyroid stimulating hormones (TSH) is produced by the _______ to stimulate the thyroid to produce thyroid hormone

pituitary

Reverse Trendelenburg position

places the body supine on an incline but with the head now being elevated

Pampinifiorm plexus

plexus of veins in the spermatic cord that drain into the right and left testicular veins; when a varicocele is present, dilation and tortousity may develop

Sialolithiasis

salivary duct stones; most commonly located within the submandibular gland; dilated duct containing a shadowing, echogenic focus or foci

Central zone

portion of the prostate that surrounds the urethra and encases the ejaculatory ducts. It is located at the prostatic base. It is typically the site of BPH but is rarely affected by prostate cancer. Accounts for 20% to 25% of the prostate glandular tissue

The longus colli muscle (LCM) are _____ to the thyroid

posterior

parathyroid glands are located

posterior surface to the thyroid gland

Complications from an ultrasound-guided biopsy are usually minor and may include

postprocedural pain or discomfort, vasovagal reactions, and hematomas. Serious complications, although rare, include bleeding, hemorrhage, pneumothorax pancreatitis, biliary leakage, peritonitis, infection, and possibly death

pyramidal lobe

present in a small percentage of patients; normal variant, extends superiorly from the isthmus

Inguinal hernia

protrusion of a loop of the intestine through layers of the abdominal wall in the inguinal region

Anaplastic carcinoma -

rare, undifferentiated carcinoma occurring in middle age

Euthyroid

refers to a normal functioning thyroid gland

Branchial cleft cyst

remnant of embryonic development that appears as a cyst in the neck; benign congenital neck cysts found most often near the angle of the madible

thyriodectomy

removal of the thyroid gland

seminal vesicles

reservoirs for sperm located posterior to the bladder

The ______ is the most common malignant neoplasm of the testicles; is a germ cell tumor that typically found in males between 30 and 50 years of age; found in patients suffering from cryptorchidism; most unilateral; seminomas are radiosensitive and chemosensitive resulting in the most favorable prognosis of all testicular tumors.

seminoma

Gonorrhea

sexually transmitted disease that leads to infection of the genitals

Common cause of epididymitis in younger men (under 35 years of age) are the

sexually transmitted diseases chlamydia and gonorrhea

Cremasteric artery

small artery arising from the inferior epigastric artery (a branch of the external iliac artery), which supplies the peritesticular tissue, including the cremasteric muscle

Epidermoid cyst

small benign mass within the testicle that contains keratin

The sonographer should look for _____ in a thyroid mass; a higher percentage of positive cells are observed

small calcifications

Urethra

small membraneous canal that extends from the bladder to the end of the penis

Isthmus

small piece of thyroid tissue that connects the right and left lobes of the gland

Extratesticular cysts

spermatocele, epididymal cyst, and tunica albuginea cyst

TNM classification

staging technique for prostate cancer. "T" refers to tumor size, "N" refers to lymph node involvement, and "M" refers to the presence of metastasis.

Hands free technique

standardise handling of sharp instruments during surgery; decreasing the risk of occupational exposure.

spermatic cord

structure made up of vas deferens, testicular artery, cremasteric artery, and pampiniform plexus that suspends the testis in the scrotum

The thyroid gland is ____ to the clavicles

superior

base

superior region of the prostate

orchiopexy

surgery of an undescended testis in the scrotum

Transurethral Resection of the Prostate (TURP) - surgical procedure most often used to treat men with BPH. A portion of the prostate is removed by a cystoscope to relieve pressure on the urethra

surgical procedure most often used to treat men with BPH. A portion of the prostate is removed by a cystoscope to relieve pressure on the urethra

Thoracentesis

surgical puncture of the chest wall for removal of fluids; usually done by using a large-bore needle

paracentesis

surgical puncture to remove fluid from the peritoneal cavity.

recurrent rami

terminal ends of the centripetal arteries that curve backward toward the capsule

Centripetal artery

terminal intratesticular artery arising from the capsular arteries

Prothrombim Time (PT)

test to evaluate blood clotting. Protein produced by the liver.

Blue dot sign

the appearance of a torsed testicular appendage that can be observed as a blue dot just under the skin surface

Trendelenburg position

the body is laid supine, or flat on the back on a 15-30 degree incline with the feet elevated above the head.

Ascites

the build up of fluid in the space between the lining of the abdomen and abdominal organs

Wharton duct

the duct that drains the submandibular gland

PT (prothrombin time) is used to evaluate factors found in

the extrinsic pathway

Colloid

the fluid produced by the thyroid that contains proteins and thyroid hormones

Hot nodules

the hyperfunctioning thyroid nodules seen on a nuclear medicine study that are almost always benign

Cold nodules

the hypofunconing thyroid nodules seen on a nuclear medicine study that have malignant potential

Pudendal artery

the internal and external pudendal arteries partially supply the scrotal wall and epididymis and occasionally the lower pole of the testis

Intrathyroidal parathyroid adenoma

the lack of echogenic line of separation. - surrounded by normal tissue

vas deferens

tube that connects epididymis to the seminal vesicle

transitional zone

two small glandular areas located on either side of the proximal urethra. Comprises approximately 5% of the gland. It cannot be distinguished from the central zone by ultrasound

There are still a small percentage of lesions that cannot be seen by ultrasound. These are typically

typically isoechoic lesions, especially in the liver.

Hypothyroidism

under secretion of thyroid hormones

In a renal transplant procedure, the ________ of a transplant kidney is biopsied to avoid possible lacerations of the main renal vessels and ureter

upper pole

The patient with a thoracentesis should be scanned in the same position that the procedure will be performed, which is usually _______

upright (sitting)

Common cause of epididymitis in men older than 35 years old

urinary tract infection

Fine-needle aspiration

use of a fine-gauge needle to obtain cells from a mass

cordocentesis

usually done after 18 weeks of pregnancy, can be used to detect certain genetic discord's, blood conditions and infections. It can also be used to deliver blood and medication to the fetus via umbilical cord

pyocele

will also show low-level echoes form pus resulting from infection.